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Stillbirths “absent from global health agenda”

The annual number of stillbirths around the world is more than double the number of people who die from HIV-related causes, according to a new report that says this widely overlooked epidemic could be dramatically mitigated with better antenatal care.

Some 2.64 million foetuses die after the 28th week of pregnancy, most of them in low- and middle-income countries, according the report published by The Lancet.

While the number of stillbirths globally has fallen from an estimated three million in 1995, the decline lags behind progress in reducing deaths in children under the age of five. The series authors say the lack of recognition of the issue at a global health level means not enough is being done to prevent more babies from dying.

“Parental groups must join with professional organizations to bring a unified message to UN agencies regarding the need to include stillbirths in global health policy.”

The authors report that grieving mothers are often disenfranchised from their communities; stillbirths can also affect future parenting and lead to divorce. In many countries, bereavement counselling is not widely available for families dealing with depression after a stillbirth.

“Behind the statistics are individual stories of families devastated by the loss of their precious child,” Janet Scott, research manager at Sands, a British stillbirths and neonatal death charity, said in The Lancet. “A baby who dies before he or she is born is no less loved and cherished, the grief and pain for the parents no less agonizing and enduring, and the guilt at not being able to protect that child no less intense.”

According to the UN World Health Organization, the five main causes of stillbirth are childbirth complications, maternal infections in pregnancy, maternal disorders such as hypertension and diabetes, foetal growth restriction and congenital abnormalities.

t Madiany Hospital in Rarieda District in western Kenya’s Nyanza Province, doctors and midwives deal with stillbirths on a daily basis; health workers are overwhelmed by expectant mothers from the entire district, even though the number of women who seek antenatal care is a mere fraction of what it should be.

“We are just one hospital serving a whole district with a huge population. To reduce cases of irregular antenatal visits among pregnant mothers – one of the biggest contributing factors to stillbirths – we need to build the capacity of lower level health centres to provide antenatal care,” Sylvia Warom, in charge of the hospital’s maternity ward, told IRIN.

“Many women come to the hospital when they realize they are pregnant and you never see them again until they are ready to deliver; it is unfortunate because many come to deliver already dead children,” she added.

In rural Nyanza, health centres are few and far between, and many women lose their babies on the long journey from home to the hospital, while others lose babies by choosing to deliver at home. More than half of all Kenyan women deliver their babies without the benefit of skilled medical professionals.

According to The Lancet series, an estimated 1.2 million of all stillbirths happen during labour and delivery, highlighting the need to increase the number of women delivering babies with skilled birth attendants present.

Better healthcare, better data

“In Uganda only 42 percent of women receive skilled attended delivery,” said Robina Biteyi, national coordinator of the Uganda chapter of The White Ribbon Alliance, an international maternal health NGO. “It is estimated that 15 percent of all pregnancies are likely to develop life-threatening complications and will need emergency obstetric care but in Uganda, only 24 percent have access to it.”

The authors of The Lancet series noted that measures to reduce stillbirths often overlapped with those to reduce maternal and child deaths. Some recommended interventions include: skilled care at birth and emergency obstetric care taking priority in settings with the highest burden and the weakest health systems; provision of basic information and service access to health-care users and ensuring health-care providers have skills, knowledge, and resources.

Other measures include the provision of folic acid supplements, supplying insecticide-treated nets in malaria-endemic areas and routine syphilis screening during antenatal visits.

“We need to improve access to family planning; there is an unmet need for family planning of 41 percent in Uganda,” said Biteyi. “There is also an urgent need to increase the number of health workers and improve their services of employment and ensure retention; currently Uganda is short of 2,000 midwives,” said Biteyi.

The authors further noted that there was a dearth of information on the subject of stillbirths, and to effectively tackle the problem it would be necessary to develop mechanisms to monitor stillbirths and better understand their causes.